Chapter 13 Care of the Patient with a Sensory Disorder

Chapter 13

Care of the Patient with a Sensory Disorder

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.


Care of the Patient with a Sensory Disorder The sensory system constantly gathers

information through millions of receptors scattered throughout the body and delivers it to the brain

Five major senses:– taste– touch– smell– sight – hearing


Normal Aging Crystalline lens of the eye harden and

becomes too large for the eye muscle – loss of accommodation

The crystalline lens also loses some transparency and becomes more opaque – glare begins to be a problem

Pupil becomes smaller and decrease amount of light that reaches the retina – patient needs more light to read


Normal Aging (con’t) Ear – loses ability to hear high

frequencies and distinguish consonant sounds

Remaining senses have slight changes causing decreased reaction or threshold time – slower responses and diminished sensation


Laboratory and Diagnostic Examinations After the normal Snellen’s test,

additional eye test may be required – Amsler’s chart – detect defects of the

macular area of the retina– Goldmann perimetry tests – detects

and evaluates intraoccular pressure– Exophthalmometry – measures the

degree of forward placement of the eye– Slit-lamp – examines the conjunctiva,

lens, vitreous humor, iris, and cornea


Applanation Tonometry

(Figure 13-12)


Eye Disorders - Nursing Consideration Initial consideration – review of following

items:– Eye pain, pruritus, excessive tearing, floaters,

light flashes, discharge, visual changes, or blind spots

– History of allergies– Current medication, and side effects, for the

eye disorder– Use of glasses or contact lenses– Adequacy of current eyewear prescription– Personal habits related to care of eyewear– Any previous eye injuries or surgeries


Disorders of the Eye Blindness and near blindness – individuals

with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced by 20 degrees

Refractory errors – astigmatism, strabismus, myopia, and hyperopia

Inflammatory and infectious disorders Myopia – elongation of the eyeball Hyperopia – inability to see things at close

range Macular degeneration – slow, progressive

loss of central and near vision


Other Disorders Glaucoma – elevated pressure within

an eye because of obstruction of the outflow of aqueous humor – Open-angle – common form of the

disease that progresses slowly– Closed-angle – occurs when sudden

blockage occurs– Treatment - Medications and surgery


Surgery of the Eye Trauma to the eye can result in need for

surgery– Enucleation – surgical removal of the

eyeball– Corneal Transplants – implantation of

donor cornea– Retinal detachment – retina separates

from the choroid in the posterior area of the eye – cryosurgery or scleral buckling are usual treatment

– Vitrectomy – removal of excess vitreous fluid caused by hemorrhage


Ear Disorders – Nursing Considerations After general assessment, additional

information would include the following:– Occurrence of ear drainage, tinnitus,

vertigo, wax buildup, pressures, pain, and pruritus

– Behavioral clues indicating hearing loss– History of medications used for ear

disorders– Current medications and side effects– Speech pattern abnormalities– Use of assistive hearing device– Home remedies that cause ear trauma


Disorders of the Ear Inflammatory and infectious –

external otitis, otitis media, and labyrinthitis

Obstructions of the ear – excessive secretions of cerumen or foreign bodies

Noninfectious disorders – otosclerosis (chronic progressive

deafness) – meniere’s – inner ear problem causing

vertigo and tinnitus


The Inner Ear

(Figure 13-4)


Surgery of the Ear Tympanoplasty – designed to restore

or improve hearing with conductive hearing loss

Myringotomy – surgical incision of the eardrum to relieve pressure and purulent exudate


Nursing Diagnoses Health

maintenance, ineffective

Anxiety Self-care deficit Fear Environmental

interpretation syndrome, impaired

Risk for injury

Home maintenance, impaired

Social interaction, impaired

Loneliness, risk for

Sensory perception, disturbed

Social isolation

Chapter 13 Care of the Patient with a Sensory Disorder

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